I’m often asked by psychotherapists and coaches whether it’s a good idea to take on narcissistic clients. Unfortunately, there’s no definitive answer.


Narcissism is a continuum. Your potential client may have many traits, high on the continuum. Or s/he may have just a few, and they may be weak, strong, or a combination. If a client is at the low to low-moderate end of the spectrum and has high self-awareness, strong motivation, and some level of caring for others, s/he may be a candidate for change. If she lacks these things, maybe not. True change involves the ability to see what she’s doing, take responsibility for it (that’s take responsibility for it – not a narcissist’s strong suite), and the ability to stay with a change process.


Both narcissism and psychopathy are mediated by differences in the brain, for example, in the amygdala, the ventro-medial prefrontal cortex, and the left anterior insula. N/Ps do not have the neural matter and connectivity required for empathy and caring. Psychotherapy and coaching reprogram the brain, creating new neural pathways for more positive, healthy ways of being. So the question is: “Can we do enough reprogramming to ‘meet’ the level of deficit for a particular client?” At this stage, the answer seems to be: We need to try it and see. There’s no other way right now.


• It is possible for some clients to change a great deal, make excellent progress in some areas of life, and leave narcissistic traits largely unchanged.


The bottom line for therapy is that at some stage your client will need to see who she truly is, and acknowledge her motivations and her behavior – not through the very murky veil of narcissistic self-idealization – but as she really is. Few have the courage to do so and most finish the therapy process before the work is done.


• If your client has a high level of narcissism – perhaps a diagnosable level, it’s likely you’re in for a very bumpy ride: She’ll do her best to violate boundaries, dump her narcissistic rage, and of course she’ll do whatever she can to pay you as little as possible. And if she doesn’t do the work of seeing herself as she really is, she’ll leave the process with you before it’s done and you have one angry projecting narcissistic ex-client who just like narcissists in any situation, really, really, needs someone else to blame. In this case, she may find ways to attack her former therapist and do her best to ruin her reputation. Think very hard before taking on a deeply narcissistic client!


• For coaches, it’s a bit different. You may be able to get on with the job of, for example, helping your narcissistic client uncover his life purpose, set goals and work towards business success quite well. The trouble is, you mightn’t like the way he goes about doing it. I personally don’t continue the work with someone if I find he’s violating the bounds of ethical behavior, or planning a course of action that will do so and is not willing to change his approach.


On the other hand, I love to work with clients who suffer a low level of narcissism and truly want to do the work to change it. Most narcissistic traits even in small doses are very destructive of the sufferer and play havoc with intimate relationships and even friendships. Those with only low levels of narcissism generally work well at the coaching level, and achieve vast improvement in overall well-being.